Provider Demographics
NPI:1245566066
Name:OPTIMAL LIFE INC
Entity Type:Organization
Organization Name:OPTIMAL LIFE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CARLET
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-223-5158
Mailing Address - Street 1:323 W DRAKE RD
Mailing Address - Street 2:SUITE 216
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-8115
Mailing Address - Country:US
Mailing Address - Phone:970-223-5158
Mailing Address - Fax:970-223-5158
Practice Address - Street 1:323 W DRAKE RD
Practice Address - Street 2:SUITE 216
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-8115
Practice Address - Country:US
Practice Address - Phone:970-223-5158
Practice Address - Fax:970-223-5158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-29
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5502111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty